Transvascular nerve stimulation apparatus and methods

Abstract

Electrode structures for transvascular nerve stimulation combine electrodes with an electrically-insulating backing layer. The backing layer increases the electrical impedance of electrical paths through blood in a lumen of a blood vessel and consequently increases the flow of electrical current through surrounding tissues. The electrode structures may be applied to stimulate nerves such as the phrenic, vagus, trigeminal, obturator or other nerves.

What is claimed is:   
     
       1. A nerve stimulation system, comprising:
 a first electrode structure configured to be placed intravascularly, the first electrode structure comprising a first plurality of first electrodes, the first electrodes being electrically discrete from each other; 
 a second electrode structure configured to be placed intravascularly, the second electrode structure comprising a second plurality of second electrodes, the second electrodes being electrically discrete from each other; and 
 a stimulation signal generator operable to transmit stimulation signals to the first and second pluralities of electrodes; 
 wherein at least one of the plurality of first electrodes includes a portion exposed through a corresponding window in an electrically-insulating wall portion of the first electrode structure, and at least one of the plurality of second electrodes includes a portion exposed through a corresponding window in an electrically-insulating wall portion of the second electrode structure. 
 
     
     
       2. A nerve stimulation system according to  claim 1 , wherein the first plurality of electrically discrete electrodes comprises at least two electrodes spaced apart circumferentially from each other around the first electrode structure. 
     
     
       3. A nerve stimulation system according to  claim 2 , wherein the second plurality of electrically discrete electrodes comprises at least two electrodes spaced apart longitudinally from each other along a length of the second electrode structure. 
     
     
       4. A nerve stimulation system according to  claim 1 , wherein the first electrode structure includes a cylindrical configuration, and the plurality of first electrodes is arranged in an array, and the array includes a plurality of rows of first electrodes extending around the first electrode structure and plurality of columns of first electrodes extending along a length of the first electrode structure. 
     
     
       5. A nerve stimulation system according to  claim 4 , wherein the second electrode structure includes a cylindrical configuration, and the plurality of second electrodes is arranged in an array, and the array includes a plurality of rows of second electrodes extending around the second electrode structure and plurality of columns of second electrodes extending along a length of the second electrode structure. 
     
     
       6. A nerve stimulation system according to  claim 1 , wherein at least one of the first electrode structure or the second electrode structure is expandable. 
     
     
       7. A nerve stimulation system according to  claim 1 , comprising a blood chemistry sensor. 
     
     
       8. A nerve stimulation system according to  claim 1 , wherein the stimulation signal generator comprises an implantable pulse generator. 
     
     
       9. A nerve stimulation system according to  claim 1 , wherein the stimulation signal generator is configured to regulate the generation of stimulation signals in response to a signal from a sensor. 
     
     
       10. A nerve stimulation system according to  claim 9 , wherein the sensor comprises at least one of an accelerometer or a blood chemistry sensor. 
     
     
       11. A nerve stimulation system according to  claim 9 , wherein the stimulation signal generator is configured to cause simultaneous delivery of stimulation signals to the first and second plurality of electrodes. 
     
     
       12. A nerve stimulation system according to  claim 1 , comprising a plurality of electrical leads connected to transmit signals from the signal generator to the first and second pluralities of electrodes. 
     
     
       13. A nerve stimulation system according to  claim 1 , comprising a wireless control signal transmission system operative to transmit the signals from the signal generator to the first and second pluralities of electrodes. 
     
     
       14. A nerve stimulation system according to  claim 1 , wherein the first and second pluralities of electrodes are connectible to the signal generator in a bipolar arrangement. 
     
     
       15. A nerve stimulation system, comprising:
 a lead structure defining a longitudinal axis along a length of the lead structure; 
 a first plurality of first electrodes on the lead structure, the first electrodes being electrically discrete from each other, wherein each of the first electrodes is exposed through a corresponding window in a first exterior wall portion of the lead structure, and wherein the first exterior wall portion includes a non-conductive material; and 
 a second plurality of second electrodes on the lead structure distally of the first electrodes, the second electrodes being electrically discrete from each other, wherein each of the electrodes of the second plurality of electrodes is exposed through a corresponding window in a second exterior wall portion of the lead structure, 
 wherein the first and second pluralities of electrodes are configured to be placed intravascularly. 
 
     
     
       16. The nerve stimulation system of  claim 15 , wherein the first plurality of electrodes includes a plurality of pairs of first electrodes, and the second plurality of electrodes includes a plurality of pairs of second electrodes. 
     
     
       17. The nerve stimulation system of  claim 15 , wherein at least two electrodes of the first plurality of electrodes are spaced apart circumferentially from each other around the lead structure. 
     
     
       18. The nerve stimulation system of  claim 17 , wherein at least two electrodes of the second plurality of electrodes are spaced apart longitudinally from each other along the length of the lead structure. 
     
     
       19. The nerve stimulation system of  claim 15 , wherein the nerve stimulation system is configured to transmit an electrical current from only a portion of a circumference of the lead structure, wherein the circumference is defined at a single cross section of the lead structure. 
     
     
       20. The nerve stimulation system of  claim 15 , wherein the first plurality of electrodes includes a plurality of rows of first electrodes and a plurality of columns of first electrodes. 
     
     
       21. The nerve stimulation system of  claim 20 , wherein the second plurality of electrodes includes a plurality of rows of second electrodes and a plurality of columns of second electrodes. 
     
     
       22. A nerve stimulation system, comprising:
 a lead structure defining a longitudinal axis along a length of the lead structure; 
 a first plurality of first electrodes on the lead structure, the first electrodes being electrically discrete from each other, wherein each of the first electrodes is exposed through a corresponding window in a first non-conductive exterior wall portion of the lead structure, the first electrodes include at least two rows of first electrodes parallel to the longitudinal axis of the lead structure, and the two rows of first electrodes are spaced apart circumferentially from each other around the lead structure; and 
 a second plurality of second electrodes on the lead structure distally of the first plurality of electrodes, the second electrodes being electrically discrete from each other, wherein each of the second electrodes is exposed through a corresponding window in a second non-conductive exterior wall portion of the lead structure, the second electrodes include at least two rows of second electrodes parallel to the longitudinal axis of the lead structure, and the two rows of second electrodes are spaced apart circumferentially from each other around the lead structure, 
 wherein the first and second pluralities of electrodes are configured to be placed intravascularly. 
 
     
     
       23. The nerve stimulation system of  claim 22 , wherein the first plurality of electrodes includes a first plurality of pairs of electrodes, and the second plurality of electrodes includes a second plurality of pairs of electrodes. 
     
     
       24. The nerve stimulation system of  claim 23 , wherein the nerve stimulation system is configured to activate a bipolar pair of the first plurality of pairs of electrodes to emit an electrical field extending radially outward between a first electrode of the bipolar pair and a second electrode of the bipolar pair. 
     
     
       25. The nerve stimulation system of  claim 22 , wherein the nerve stimulation system is configured to transmit an electrical current from only a portion of a circumference of the lead structure, wherein the circumference is defined at a single cross section of the lead structure. 
     
     
       26. The nerve stimulation system of  claim 22 , wherein the length of the lead structure is sufficient for insertion of the lead structure into all of the following at a same time: a) at least one of a left subclavian vein and a left jugular vein; b) a left brachiocephalic vein; and c) a superior vena cava.